This PDF document was made available from www.rti.org as a public service of RTI International. More information about RTI Press can be found at http://www.rti.org/rtipress. RTI International is an independent, nonprofit research organization dedicated to improving the human condition by turning knowledge into practice. The RTI Press mission is to disseminate information about RTI research, analytic tools, and technical expertise to a national and international audience. RTI Press publications are peerreviewed by at least two independent substantive experts and one or more Press editors.

No abstract

The American College of Obstetricians and Gynaecologists recommends that immediate postpartum intrauterine devices be offered as part of comprehensive family planning. Immediate postpartum intrauterine devices are not widely disseminated in clinical practice and little is known about how prenatal counselling strategies impact device use. Our objective was to examine the impact of variable prenatal counselling practices on device uptake. We conducted a retrospective case-control study of patients who obtained an immediate postpartum intrauterine device (cases, n=110) at a major academic birthing facility over a three-year period. Controls (n=205) had a live birth during the same period and received no or some other form of contraception before hospital discharge. We examined the timing and frequency of contraceptive counselling and used logistic regression to estimate odds ratios of device receipt adjusted for demographic and obstetric characteristics. 15% of cases and 36% of controls had no documentation that prenatal contraceptive counselling was offered or delivered (P value <.001 (chi square test)). Cases had significantly more total documented counselling sessions (mean 2.6 vs 1.7; odds ratio 1.23; 95% confidence interval, 1.09-1.38) and more third trimester counselling (mean 2.24 vs. 1.36; odds ratio 1.33; 95% confidence interval, 1.16-1.53) compared to controls. Counselling on admission to the labor ward and provider type were not significant in adjusted models. When accompanied by outpatient prenatal counselling, those who received counselling on admission to the labor ward were five times more likely to receive a device. Given time constraints during prenatal visits, contraceptive counselling clustered in the third trimester followed by counselling on admission to the labor ward may be a reasonable way to offer immediate post-placental intrauterine devices. To promote reproductive autonomy and justice, comprehensive prenatal contraceptive counselling should be offered to all.

No abstract

Introduction: In this case report we discuss the presentation and management of a woman with a large adnexal mass. Case Report: This report describes a 32-year-old year healthy woman who presented with four months of increasing abdominal fullness. Computed tomography (CT) imaging showed a 34 cm fluid-filled left adnexal mass with few thin septations. Tumor markers were within normal limits. She strongly desired minimally invasive surgery in the setting of low concern for malignancy. A mini-laparotomy was performed, purse string sutures were placed through the cyst wall, and fluid was aspirated with minimal spillage. Her left tube and ovary were resected laparoscopically. Intraoperative frozen pathology returned as mucinous cystadenoma with some areas of atypia. Final pathology resulted with Grade 2 mucinous adenocarcinoma and she was taken back to the operating room for a surgical staging procedure. Pathology from her laparoscopic staging surgery was benign. She underwent chemotherapy with carboplatin/paclitaxel for Stage 1C1, Grade 2 mucinous adenocarcinoma of the ovary based on intra-operative spillage. Conclusion: Despite reassuring imaging and tumor markers, particularly in the setting of frozen pathology with low concern for malignancy, final pathology may indicate carcinoma. Although the accuracy of intra-operative frozen pathology is generally high, both gynecologic oncologists and non-oncologic gynecologists should be aware of the limitations of the test and counsel patients that the final pathology may be discordant. Appropriate counseling about the risk of intra-operative spillage and subsequent upstaging is of particular importance.